Appear on the june 4th, board of supervisors agenda, unless otherwise stated. Please read items one and two together. Hearing regarding the City Services regarding but not limited to Supportive Housing with Wraparound Services and adequate beds, Mental Health counciling and psychological services, resources and to serve the population. Item number 2 is an ordinance amending the health code to authorize procedures for the appointment of a conservator for someone caring for health and wellbeing due to a serious Mental Illness and Substance Use disorder, and designating the City Attorney to institute the initial proceedings. Thank you so much. We continue this item from last week, i know the Mayors Office has the presentation, i dont know if you want to make any opening remarks, supervisor mandelman . Only to thank the members of committee for taking the time last week and again this week. I know there were some Unanswered Questions from Committee Members last week and im hoping there have been fruitful conversations over the last week. My hope is that we will be able to bring this to committee today thank you. I want to thank the Mayors Office and especially the policy director for sending this followup memo, which was very helpful. I still have some questions, but that is exactly what i was looking for. Thank you so much. Do you want to do a presentation for us, or should be launched directly into questions . Okay, thank you. Good morning. Im with the department of Public Health and Behavioural Health services. I have a short presentation to go over some of whats in the memo and reorient us back to the conversation regarding s. B. 1045 or the housing conservatorship. I also want to echo the appreciation to the supervisors in the community for the robust conversation we had last week. This is an overview of what we will discuss today in our presentation. Again, just to reorient us to the conversation, the landscape in which we are providing Behavioural Health services has drastically changed since the enactment of the act. And in San Francisco, we have a methamphetamine and opioid epidemic. There were individuals with complex Behavioural Health needs that are vulnerable in our communities and are unable to care for themselves. For some individuals, when they are unable to accept volunteer services, they cycle into communities and deteriorate, and in extreme circumstances, this can lead to death. As a reminder, the medical examiner reported last year that for individuals who are experiencing homelessness of the time of their death, 35 died subsequent from overdose, and 50 2 had substances in their system. San francisco has a long history of being innovative and adapting to the needs of our community with programs such as assisted outpatient treatment, and s. B. 1045 is an innovative and narrow tool that would be used to serve vulnerable individuals. In order to be eligible for the housing conservatorship, an individual must meet certain criteria, including being able unable to care for their health and wellbeing, have a current diagnosis of sears middle illness and Substance Use disorder, have frequent and voluntary detentions, that is defined by eight involuntary holds or 5150 in the preceding 12 months, and a. O. T. Has been determined by the court to be insufficient for or the individual does not qualify. When we did a deeper dive, we found that 55 individuals met this criteria, which is not to say the 55 individuals would be conserved under this pilot program, but it is potential for those cases, which represents one point 5 of the population served by Psychiatric Emergency Services, in less than 1 of the services of the population served by Behavioural Health services. For the people who were we are discussing, this is a case example we shared last week. This is there experience. For somebody like Melanie Melanie is a woman in her thirties, diagnosed with schizophrenia and severe methamphetamine addiction. She is under crisis, and her Mental Health systems are a cute she is seen running in the streets, taking her clothes off, and not caring for open wounds. She shes appropriate leap placed on an involuntary hold, and brought to Psychiatric Emergency Services for immediate treatment. Which when she is no longer under the influence of substances, she is no longer acute in terms of her Mental Health systems. She can have meaningful conversation, identify resources , and care for herself. Because of that, she is unable to be legally held. While she is offered volunteer services, she declines these services, saying she is fine, it doesnt need anything. She relaxes in the community, and the cycle continues. For people like melanie, what we know is she is deteriorating every time we see her. S. B. 1045 could be a mechanism to support getting her into care one of the Unanswered Questions that we heard last week is looking at a flow for someone like melanie and how she would enter into a housing conservatorship. We wanted to take an opportunity to discuss that, and also discuss how senate bill 40 might shift how she would enter into a housing conservatorship. Voluntary services are our top priority for anyone, including melanie. She accepted voluntary voluntary services and we would be able to provide her with those services. In this situation, for melanie, at the sixth involuntary hold, if she had not yet been referred to assistant outpatient treatment, she would be referred at that point. She would be outraged and engaged by the assistant outpatient team which includes peer and clinical based services , and we employ a whatever it takes and wherever it takes approach. For unsuccessful engaging melanie involuntary services, a petition would be filed with the court, and if granted, should be ordered to participate in outpatient treatment. If a. O. T. Continues to be unsuccessful in stabilizing her in the community, and it is determined shes a higher level of care, she would be referred to the public conservators office. At the eighth involuntary hold or 5150, she would be informed that the public conservator may submit a petition to the court. At this point, the Public Defenders Office would be informed, and the public conservators office would have an investigation to determine if she meets the criteria for housing conservatorship. This would include a facetoface conversation with melanie, and the development of the service plan, which would be in the least restrictive setting melanie would receive a notice of a petition, and would be supported in meeting with the Public Defenders Office. This would occur through outreach teams, including the Homeless Outreach team and the assisted outpatient treatment team. I can share that in 100 of cases, we were successful in supporting that individual in meeting the public defender in the community. In order to support melanie to attend court, we would have reached out to her before the court date, we would remind her of her court date, and offer her assistance in attending court which could be via taxi, public transportation, or a city vehicle, whichever she is most comfortable with. We would also see her the morning of court to remind her of her court date in some and support her in attending court. At no point, would Law Enforcement used to transport her to court. I just want to reiterate the importance of building that relationship with melanie and i think in assisted outpatient treatment, we have seen that Relationship Building is what has supported us with the individuals attending their court date. At that point, a hearing would occur, or a jury trial. If that is what is requested. If granted, she would be ordered to participate in the treatment plan that the court approves. This is really using the symbolic wait of the court to leverage someone into care. You conservatorship would last no longer than 12 months, but could end sooner if it is determined that she doesnt continue to meet the criteria for conservatorship. Throughout this time, she would receive intensive Wraparound Services, and potential treatment plan for some be like melanie might include an initial placement at the Healing Centre, and then having the opportunity to have uninterrupted care where she is able to stabilize and we can have conversations regarding harm reduction, and engage her in motivational interviewing. Should then be able to transition to a program, followed by a coop, all the while working with an intensive case manager, potentially through citywide, who also provides peerbased services, and ultimately, when she is clinically ready, being placed in permanent Supportive Housing. Before we go on, how will that change can i go through questions about how it would work under the current law . So first of all, the case manager that has been working with melanie already, how many clients does that case manager serve . Through assisted outpatient treatment, the ratio is 110 clients. So melanies case manager has ten clients . Correct. Does that allow the case manager to, you know, spend a lot of time with melanie . Absolutely. So that Team Includes clinicians , and also peerbased services, it is through citywide Case Management, so provides a lot of opportunity to outreach melanie multiple times, sometimes daily, depending on the needs of that individual, and building that relationship where an individual is and the trajectory of their care. The department of Public Health, our a. O. T. Care team supports that work and the individual through our services, so if more intensive services are needed, we Work Together to be able to provide those. So melanie has already been referred to a. O. T. Correct. Okay. And she is homeless. Correct. So the case manager has been able to find her and knows where she sleeps on a regular basis. Despite that daily interaction, she refuses to accept any voluntary services at all . Correct. Okay. , so if we look at this, i will also look at the memo that was submitted to me ahead of time. So once it is determined that a housing conservatorship is going to be pursued on behalf, or for melanie, so you say that the public defender is going to be the one to inform melanie of this . Because you have, in step nine, the public defender meets with melanie. Correct. So how is that going to happen . And is the public defender here . I believe she is on her way. I spoke to her prior to the hearing. I do not see her yet. Okay. Because i was assured that the public defender would be here. That is who i have a ton of questions for today. I know she was in a car on her way before we started, so she should be here momentarily. Okay. Maybe that is her. No such luck. So the public defender, with the help of a. O. T. Team in the case manager, and the hot team, find melanie, and i really want to talk about the public defender and talk about what that conversation looks like, and how that relationship goes forward, but here it says that i will wait until she gets here before i have that conversation, what it says, if melanie does not agree to come to court, she will be compelled by Law Enforcement to attend. So i believe it said she will not be compelled by Law Enforcement, just to clarify. Okay. Thank you i read that wrong. The only way we are going to get melanie to go to court is through the help of the public defender and the hot team. And or the assisted outpatient treatment, which we do on a regular basis. And this is where i just dont believe that this is a practical, workable plan, because you said you have a case manager that is working with melanie daily, and yet she was refused to participate in any of these services, so she doesnt want to participate in services, and knows she will be involuntarily conserved if she goes to court, i just failed to see how melanie is going to go to court. I am frustrated that the public defender is not here, because that is who i have the majority of questions for on this. I guess maybe we should continue with your presentation while were waiting and circle back to that. Okay. I would like to take a second to talk about how as be 40 would adjust this process. Senate bill 40 would reduce the length of the conservatorship from 12 months to six months, and the individual would be notified at the seventh involuntary hold of a possible future conservatorship, rather then the eighth, and at this point, an individual could be placed on a temporary conservatorship which could last up to 28 days. Again, i think that this is important because it gives us that time to stabilize an individual, and in some cases, you conservatorship may not need to proceed, but they could be stabilized in that 28 day period and transitioned to voluntary services. Will that individual be held in the locked award at s. F. General . It would depend on the individuals needs. It could be at the hospital, where they could be placed somewhere like the Healing Centre for that time period. Okay. But it would be a lock towards. Correct, in most situations. This also mirrors the treatment language, but the conservators office would have to provide a report to the court every 60 days to show the court that the individual continues to meet criteria for conservatorship, and what the treatment plan is for them, and if they better be served in a less restrictive setting, which is a legal and ethical responsibility for us. It also clarifies the intent of the language around the treatment for a. O. T. To be considered as the least restrictive option, but to not preclude us from moving forward if somebody does not meet the criteria. So this process will look very similar, but theres a couple of things that i would like to highlight around number 2, and this is specific to the assisted outpatient treatment language. If somebody meets the criteria for assisted outpatient treatment, and is determined to be sufficient, a Court Petition could move forward for that program. An individual it could be determined that outpatient treatment is not appropriate, or they do not meet the legal criteria, at which point it could be referred to the public conservator for consideration. Finally, assisted outpatient treatment and individuals could meet the legal requirements for that, but it is determined is insufficient to meet their needs , and so as not to delay services, they could be referred to the public conservators office. At the seventh 5150, an individual would receive notice about the possibility of a conservatorship. At the eighth involuntary hold, the Public Defenders Office would be notified, and the individual be placed on a temporary conservatorship which could last up to 28 days, and they would be a hearing in the hospital. The conservatorship lasts for six months, or could end sooner if it is determined if they meet the criteria. To be the same a treatment plan that we saw mirrored in s. B. 1045. That concludes our slides. I dont see cara yet, but im happy to follow up with her to see what her expected time of arrival is if that would be helpful. I will open this up for public comment, and then we will talk to the public defender when she gets here. So i will call the speaker cards that i have. If you can line up to my left, youre right when i call your name. Bridget brown, spencer hudson, tiny, michael lyon, teresa palmer, and anybody else would like to speak, feel free to line up. Anyone can come up and be the first speaker. Thank you. Hi, my name is bridget brown, i work for independent Living Resource Centre here in San Francisco, and i consider myself a Mental Health advocate, also, i consider myself a client with a Mental Health background. I would like to say that i could have been melanie, that could have been me. I was at a club one night and somebody put oxycontin in my drink and i ended up in the hospital. It turned out i had oxycontin in my system, and i was one of those revolving door people that they have been talking about throughout this whole s. B. 1045 issue, and i had to go to court, they wanted to conserve me, and luckily, with the blessings that i have on me, i didnt end up in a locked facility. I just want to let you know, that could have been me. It could affect people with things beyond their control and things happen to them, okay . That is all i wanted to say. Thank you. Michael lyon, Public Health justice collective. If you believe that this plant is racist, and it is, if you believe it is unfairly targeting homeless, and it does, if you believe that it puts cops in the drivers seat about who gets detained, and it does, and if you believe that the city has woefully is woefully lacking mean voluntary services, which it does, you need to stop this plan now. You need to resist the temptation to wait and see what happens with s. B. 40, because it greases the skids to detaining homeless, it removes the requirement that clients be offered a. O. T. , a removes the requirement that the city can actually supply these services, so you need to stop it now. Dont wait. Thank you, next speaker, please. Tiny, we have a Homeless People solution to homelessness that we are building right now in east oakland. I keep trying to get conscious folks in office, but also politicians to listen to that.